Introduction Continuous anesthetics are often required for the management of refractory status epilepticus. While essential to achieving seizure control, these agents carry significant adverse effects. In particular, propofol may induce hypotension, respiratory depression, metabolic acidosis, or pancreatitis, with the most feared complication being propofol infusion syndrome (PRIS). Methods The primary objective was to investigate the biological effects of propofol in patients with status epilepticus admitted to the neurointensive care unit of Pitié-Salpêtrière Hospital (Paris, France) for at least 48 h between September 2015 and October 2024. Twenty biological parameters reflecting acid–base balance, organ function, lipid metabolism, and inflammation were analyzed. To capture delayed effects, biological tests from day t + 1 were used to assess propofol exposure on day t . A linear mixed-effects model was applied, with each marker as the dependent variable, propofol exposure (including patients who did not receive propofol as the reference group) or dose of propofol as the fixed-effect predictor, and patient as a random effect. A secondary objective was to determine the incidence of PRIS in this tertiary referral center for the management of refractory and super-refractory status epilepticus. Results A total of 235 patients were enrolled, of whom 51% received propofol for at least 1 day. We collected biological data over 2,407 patient-days, including 1,086 (45%) under propofol infusion. Propofol use was associated with lipid dysregulation, characterized by increased triglycerides, decreased LDL-cholesterol and HDL-cholesterol, along with impaired renal function, and mild acute respiratory acidosis, reflected by elevated pCO 2 , and reduced pH and phosphate levels. Propofol exposure was also associated with a pro-inflammatory profile, characterized by elevated CRP, procalcitonin, leukocyte counts, and an altered neutrophil-to-lymphocyte ratio, independent of the patient’s clinical inflammatory status. Over the past 10 years, only four cases of likely or most likely PRIS cases were identified. Discussion Prolonged propofol infusions warrant routine monitoring of specific biological markers. Our study identifies key parameters to follow and confirms that PRIS remains rare in specialized centers where patients are closely monitored and risk factors are carefully considered.

Our studies have established that ureteric bud (UB) prorenin receptor (PRR/ATP6AP2), an accessory subunit of the vacuolar H+-ATPase (V-ATPase), is critical for normal UB branching. Here, we tested the hypothesis that V-ATPase activity, acidosis and UB cell intracellular pH (pHi) regulates UB branching morphogenesis during kidney development. The effect of specific V-ATPase inhibitor Bafilomycin, hypercapnic (high CO2) and metabolic (low HCO3-) acidosis on UB branching were determined in whole intact E12.5 Hoxb7GFP+ mouse kidneys grown ex-vivo by time-lapse photomicroscopy. The effect of Bafilomycin on UB cell migration in vitro was examined using transwell migration assay (n=3 wells/treatment group). The presence of V-ATPase and Na+-H+ exchanger (NHE) activity in UB cells was investigated by measurements of intracellular pH (pHi). The ability of UB cells to regulate cell pHi in vitro was determined by measurements of Na-dependent and Na-independent pHi recovery from acid loads. The mean number of UB cells that migrated through membrane after 24h culture was reduced with Bafilomycin compared to control. Treatment with Bafilomycin, hypercapnic acidosis (induced by high CO2) or metabolic acidosis (induced by low HCO3- concentration) in the culture media caused a marked reduction in the number of UB tips compared to control. We conclude that intact V-ATPase activity is essential for normal UB branching during kidney development. V-ATPase-dependent reduction in UB cell pHi is likely a cause of decreasing UB branching by inhibiting directional movements of UB cells.

Background Sodium-glucose cotransporter-2 (SGLT2) inhibitors are increasingly prescribed for heart failure and chronic kidney disease, irrespective of diabetic status. While their cardiovascular and renal benefits are well established, euglycemic ketoacidosis (EKA) remains a rare but potentially life-threatening complication that can occur even in non-diabetic individuals. Case presentation We report a 58-year-old man with ischemic cardiomyopathy (LVEF 35%) and stage 2 chronic kidney disease who developed nausea, vomiting, and fatigue two weeks after initiating dapagliflozin. Laboratory evaluation revealed high-anion-gap metabolic acidosis (pH 7.21 [reference: 7.35–7.45], HCO 3 - 12 mmol/L [reference: 22–28 mmol/L], anion gap 23 mmol/L [reference: 8–16 mmol/L])with markedly elevated β-hydroxybutyrate (5.4 mmol/L) and normal plasma glucose (108 mg/dL). Diabetes, infection, lactic acidosis, and hepatic dysfunction were excluded. Management & outcome The SGLT2 inhibitor was discontinued, and the patient was treated with intravenous saline, insulin infusion, and dextrose. Metabolic parameters normalized within 48 hours, and he was discharged in stable condition. No recurrence was noted at three-month follow-up. Conclusion This case highlights that SGLT2 inhibitors can precipitate euglycemic ketoacidosis even in non-diabetic patients. Because normal glucose levels may obscure recognition, clinicians should maintain a high index of suspicion and perform ketone testing in patients on SGLT2 therapy who present with unexplained gastrointestinal or constitutional symptoms.

Background: Hypothermia significantly affects survival in neonates, as their thermoregulation is less effective than in older children and adults. Hypothermia can worsen metabolic processes, leading to hypoglycemia, hypoxia, and metabolic acidosis. Near infrared spectroscopy (NIRS) is useful for assessing regional tissue oxygenation (RSO2), providing insights into the oxygen supply and demand balance in vulnerable organs. Objective: This study aims to demonstrate differences in cerebral, abdominal, and renal tissue oxygenation in neonates under hypothermia and after rewarming using NIRS. Methods: An observational cross-sectional study was conducted from November 2019 to January 2020 at the NICU of Dr. Soetomo Surabaya Hospital. Neonates were divided into hypothermia, rewarming, and normothermic groups. NIRS assessments were performed during hypothermia and post-rewarming. Statistical analyses were conducted using paired t-tests or Wilcoxon tests for the hypothermia group, and independent t-tests or Mann-Whitney tests for comparisons between hypothermia and normothermic groups, with a significance level of p < 0.05. Results: A total of 106 neonates met the criteria: 51 in the hypothermia and rewarming group and 55 in the normothermic group. The average birth weight was 2261.96 ± 832.26 grams for the hypothermia group and 2009.09 ± 676.87 grams for the normothermic group. Significant differences were noted in heart rates and renal tissue oxygenation (RrSO2) between conditions, with p-values of 0.014 and 0.023, respectively. Conclusion: This study found significant differences in renal tissue oxygenation between hypothermic conditions and post-rewarming.

Both farmers and gardeners use paraquat, since it is efficient yet toxic, as it does not have a commonly used treatment if people are exposed. Common causes of death are acute respiratory distress syndrome, problems with the kidneys, and the failure of several major organs. In this study, the outcomes of patients who took part in the research were reviewed using data collected from admissions during a year period. All cases were caused by intentional self-harm, and out of these, 60% got acute kidney injury and acute respiratory distress syndrome, while 80% had a mix of metabolic and respiratory acidosis. Out of all the patients, half developed multi-organ dysfunction syndrome and a lethal outcome resulted for 50% within 24 hours. In a third of cases, the treatment was ended when family decided to discharge them against a doctor's advice, but only a fifth of patients were able to go to a high-dependency unit. Regardless of using hemodialysis, corticosteroids, and other support measures, a huge number of patients died. It is noted that paraquat poisoning is very dangerous and calls for better treatment options, where early hemoperfusion might have a positive impact on survival outcomes. Out of the herbicides registered worldwide, paraquat is the most hazardous and dangerous to people. Early use of hemodialysis, corticosteroids, and other medical support did not lead to a major drop in patients' death rates. Quick administration of hemoperfusion is a promising way to raise the survival chances of patients who are poisoned with paraquat.

This study aimed to determine whether urinary pH can be used to predict metabolic acidosis in sheep with acute rumen lactic acidosis (ALRA). ALRA was induced by administering sucrose intraruminally to 40 apparently healthy sheep. Venous blood and urine samples were collected before induction (‒18h) and prior to treatment (0h) to measure blood pH, base excess (BE), and urinary pH. Associations between urinary and blood pH, and between urinary pH and BE, were examined using Pearson correlation and linear regression. Blood and urinary pH were positively correlated (r = 0.633; P < 0.001), as were BE and urinary pH (r = 0.602; P < 0.001). The regression coefficients were r2 = 0.401 and r2 = 0.362, respectively, and the relationships were described by the following equations: pH = (urinary pH × 0.063) + 6.909; BE = (urinary pH × 3.66) ‒ 30.512. Calculated values of blood pH and BE did not differ from measured values ​​(7.346 ± 0.072 vs. 7.346 ± 0.114; P = 0.979; and ‒5.11 ± 4.21 mmol/L vs. ‒5.11 ± 6.99 mmol/L; P = 0.998, respectively). When used as a diagnostic criterion for metabolic acidosis, the BE calculated from urinary pH demonstrated a sensitivity of 81.8%, specificity of 82.5%, negative predictive value of 84.6%, positive predictive value of 79.4%, and accuracy of 82.2%. These findings indicate that urinary pH can be used as a practical predictor of metabolic acidosis in sheep with ALRA.

Objectives This report presents a rare case of congenital diarrhea and enteropathies in a Chinese infant caused by a heterozygous mutation in the GUCY2C gene. Case presentation A male infant was born prematurely with a history of polyhydramnios and prenatal intestinal dilation. He developed persistent abdominal distension, secretory diarrhea, metabolic acidosis, severe electrolyte imbalances, and failure to thrive. Whole-exome sequencing identified a heterozygous mutation in GUCY2C (c.2356T &amp;gt; C, p.Y786H), classified as likely pathogenic. The patient also exhibited intestinal malrotation but did not require surgical intervention. Management included total parenteral nutrition, transition to an amino acid-based formula, and extensive electrolyte supplementation. At the 72-month follow-up, he exhibited normal growth and complete resolution of gastrointestinal symptoms. Conclusions A heterozygous mutation in the GUCY2C gene (c.2356T &amp;gt; C) was identified as the cause of this rare congenital diarrheal disorder. These findings emphasize the essential function of genetic testing in children with chronic, treatment-refractory diarrhea and highlight the potential for excellent long-term outcomes with suitable supportive care.

IntroductionDiabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are well-recognised acute complications of diabetes, but their presentation in patients with cancer—particularly as an initial manifestation—is poorly understood. ¹ Additionally, a small subset of rapidly progressive malignancies can present with metastatic disease in the absence of an identifiable primary tumour. These are classified as cancers of unknown primary origin (CUP), accounting for 3–5% of all cancers. ² Identifying CUP poses significant diagnostic and management challenges, especially in the acute care setting.²The European Society for Medical Oncology (ESMO) and the National Comprehensive Cancer Network (NCCN) recommend thorough physical examination, comprehensive laboratory testing, and whole-body imaging (CT and PET scans) for all patients with metastatic cancer of unknown primary (CUP).²Clinical CaseWe report a rare case of a 37-year-old woman with no known history of diabetes who presented to the emergency department with symptoms of vomiting, weight loss, and persistent headaches. Initial investigations revealed hyperglycaemia, ketonuria, and metabolic acidosis consistent with DKA. Neurological symptoms prompted an urgent CT head, which revealed multiple cerebral lesions with surrounding oedema. Subsequent MRI brain confirmed multiple ring-enhancing lesions suggestive of metastases. CT thorax/abdomen/pelvis and PET scan demonstrated widespread metastatic involvement including lungs, liver, and lymph nodes, but no identifiable primary tumour. Comprehensive infectious screening (including HIV, TB, and toxoplasmosis) and tumour markers (CEA, CA-125, CA 19-9, AFP, and beta-HCG) were unremarkable. An excisional biopsy of a cervical lymph node revealed poorly differentiated adenocarcinoma, consistent with a diagnosis of cancer of unknown primary (CUP).The patient’s DKA was promptly managed with insulin therapy and fluid resuscitation. Cerebral oedema was treated with high-dose dexamethasone. The case was discussed in a multidisciplinary team (MDT) meeting, and the patient was placed on CUP pathway. On follow-up, the malignancy remained of unknown origin, and the patient was referred for palliative oncological care.ConclusionThis case highlights the rare presentation of diabetic ketoacidosis as the initial symptom of an occult malignancy, specifically cancer of unknown primary origin. It underscores the importance of a comprehensive and multidisciplinary approach when atypical features accompany common endocrine emergencies. Clinicians should maintain a high index of suspicion and consider broader differentials when metabolic disturbances coexist with unexplained neurological or systemic signs.

To identify factors associated with the development of death by neurologic criteria (DNC) in neonates treated with extracorporeal membrane oxygenation (ECMO). Retrospective registry study. Data reported to the Extracorporeal Life Support Organization registry from 2010 to 2023. Neonates (≤ 28 d old) who were supported with ECMO, excluding those born before 37 weeks' gestation or with missing gestational age data. The final cohort comprised 14,970 neonates. None. DNC occurred in 70 neonates in the cohort (0.5%), accounting for 2% of overall mortality rate. Pre-ECMO factors associated with greater relative risk ratio (RRR) of DNC included pre-ECMO cardiac arrest (RRR, 2.64), pH less than 7.08 (25th percentile: RRR, 2.06), and cardiac support type (RRR, 2.04). On-ECMO, factors independently associated with DNC included pH less than 7.35 (25th percentile: RRR, 2.76), Pao2 greater than 162 mm Hg (75th percentile: RRR, 2.75), and central cannulation (RRR, 2.36). We failed to identify an association between relative change in Paco2 greater than 50% and DNC, but it correlated with other causes of death. Most DNC diagnoses (84%) occurred after 24 hours of ECMO. DNC is rarely diagnosed in neonatal ECMO cases. Both pre-ECMO and on-ECMO factors associated with DNC included pre-ECMO cardiac arrest, severe metabolic acidosis, and cannulation type. These findings underscore the importance of optimizing pre-ECMO and on-ECMO management and may indicate certain modifiable risk factors such as optimization of cardiopulmonary resuscitation and hyperoxia. Future research should explore preventive strategies and interventions to mitigate the risk of DNC in neonates receiving ECMO.

Rationale:Acquired reactive perforating collagenosis (ARPC) is a challenging dermatological complication in end-stage renal disease (ESRD) patients on hemodialysis, characterized by transepidermal elimination of degenerated collagen and intense pruritus. Treatment options are limited and lack consensus. Based on its established safety profile in ESRD and pathophysiological rationale, we evaluated sodium thiosulfate (STS) as a novel therapeutic option for ARPC.Patient concerns:A 70-year-old male with ESRD on hemodialysis and type 2 diabetes presented with widespread pruritic papules consistent with ARPC.Diagnoses:The diagnosis of ARPC was confirmed histologically by Masson trichrome staining.Interventions:After unsatisfactory responses to topical steroids and antihistamines, intravenous STS (3.2 g after hemodialysis, 3 times weekly) was initiated.Outcomes:The patient showed marked clinical improvement in pruritus and skin lesions within 1 month, with a corresponding decrease in eosinophil count and IgE levels. No adverse effects, such as metabolic acidosis or gastrointestinal symptoms, were observed.Lessons:STS may be an effective and well-tolerated treatment for ARPC in hemodialysis patients. The observed immunomodulatory changes, though possibly related to symptom resolution, support further investigation into its mechanism of action.

Background:Propionic acidemia (PA) is a severe metabolic disorder that leads to multiorgan damage despite comprehensive management. Liver transplantation (LT), particularly living donor liver transplantation, has been proposed as an effective treatment, but evidence from large-scale studies is limited.Methods:This retrospective study analyzed clinical outcomes of 39 children with PA who underwent LT at Shanghai Ren Ji Hospital between September 2017 and October 2023. The data included demographics, surgical details, biochemical/metabolic markers, and progression of symptoms. Patients were grouped based on the Diagnosis-to-Transplant Interval (<20 vs. ≥20 mo) for comparative analysis.Results:Among 39 patients, 38 (97.4%) underwent living donor liver transplantation, and 1 received split LT. At 6 months after transplant, significant reductions were observed in propionylcarnitine/acetylcarnitine ratio (1.4 to 0.8, p=0.01), urinary methylcitrate (35.4 to 15.2, p=0.03), and 3-hydroxypropionic acid (198.8 to 6.8, p=0.02). Symptoms such as gross motor delay, metabolic acidosis, hyperammonemia, and feeding difficulties significantly improved (all p<0.001). The 5-year patient and graft survival rates were 97.4%. Short Diagnosis-to-Transplant Interval time (<20 mo) and long Diagnosis-to-Transplant Interval time (≥20 mo) also affected the results of specific PA clinical problems before and after transplantation.Conclusions:This single-center study on PA transplantation suggests that LT, especially living donor liver transplantation, effectively reduces metabolic waste, promotes metabolic stability, and enhances quality of life in pediatric patients with PA. LT represents an effective therapeutic option for patients with metabolic instability.

Malignant hyperthermia (MH) is a rare, life-threatening inherited disorder triggered by volatile inhalational anesthetics and/or the depolarizing muscle relaxant suxamethonium. In susceptible individuals, calcium release from the sarcoplasmic reticulum in the skeletal muscle becomes abnormally accelerated, leading to a hypermetabolic state. Early signs of MH include unexplained hypercarbia (end-tidal carbon dioxide > 55mm Hg), tachycardia, and muscle rigidity, particularly in the masseter. Rapid increases in core temperature (> 0.5°C/15min, with temperatures often exceeding 40°C) are typical. With progression, respiratory and metabolic acidosis, arrhythmias, cola-colored urine (myoglobinuria), elevated serum potassium, and tented T-waves may develop, potentially leading to cardiac arrest or multiorgan failure. The Japanese Society of Anesthesiologists' guidelines for the management of MH in 2025 (Japanese version) emphasize the importance of early recognition and immediate intervention. The essential steps include discontinuing triggering agents, administering intravenous dantrolene (initially 1-2mg/kg), aggressive cooling of the body, and managing complications, such as hyperkalemia and acidosis. On the basis of international standards, a higher initial dose of dantrolene is recommended. Preoperative assessment of MH risk should include history taking for anesthetic complications, a family history suggestive of MH susceptibility, signs of congenital myopathies, and careful anesthetic planning using non-triggering agents. Genetic testing and muscle biopsy may aid in the diagnosis but are not definitive in all cases. The Japanese translation of these guidelines has been posted on the following website: https://anesth.or.jp/files/pdf/guideline_akuseikounetsu . pdf.

Genetic disorders in neonates often present with overlapping clinical features, posing significant diagnostic challenges. Glycogen storage diseases (GSD) disrupt glycogen metabolism, leading to energy deficits. Pathogenic variants in the Wilms tumor 1 (WT1) gene represent a rare but significant cause of early-onset steroid-resistant nephrotic syndrome (SRNS), associated with a broad range of both kidney and extrakidney phenotypic manifestations. The coexistence of these genetic diseases in a single patient has not been previously reported. Herein, we present a case of a newborn with symptomatic hypoglycemia and metabolic acidosis that was transferred to the Neonatal Intensive Care Unit. During hospitalization, he developed hyponatremia and nephrotic-range proteinuria, a genetic test was performed, and he was transferred to the nephrology unit. Genetic analysis identified a compound homozygous mutation (c.247 C > T) in the G6PC gene, confirming glycogen storage disease type 1a (GSD-1a) and a pathogenic WT1 mutation (c.1400G > A) associated with Denys-Drash syndrome. This case highlights the importance of a multidisciplinary approach in the evaluation and management of neonates with a complex combination of genetically-determined conditions.

Nonketotic hyperglycinemia is a rare metabolic disorder caused by glycine accumulation due to defects in the glycine cleavage system. While severe metabolic disorders can theoretically affect fetal growth, nonketotic hyperglycinemia is not recognized as a common or typical cause of symmetric intrauterine growth retardation. This case report describes a Iranian 36-week male neonate with symmetrical intrauterine growth restriction, born to consanguineous parents with a history of preeclampsia and prior fetal demise. Despite initial stabilization, the infant developed metabolic acidosis, recurrent apnea, and seizures. Laboratory findings revealed elevated glycine levels (2560µmol/L), confirming nonketotic hyperglycinemia. Despite seizure management and antibiotic therapy, the infant deteriorated and died on day 11. Nonketotic hyperglycinemia typically presents with lethargy, hypotonia, seizures, and apnea, often fatal in the neonatal period. Glycine's dual role as an excitatory and inhibitory neurotransmitter explains the seizures and hypotonia seen in nonketotic hyperglycinemia. While acute symptoms may resolve, survivors face severe neurological impairment. Early recognition of nonketotic hyperglycinemia is critical for genetic counseling and palliative care. This case highlights the diagnostic challenge of nonketotic hyperglycinemia, particularly when presenting with intrauterine growth restriction, which can mimic other neonatal conditions such as sepsis or hypoxic-ischemic encephalopathy. Consanguinity and prior fetal loss should raise suspicion for metabolic disorders, and according to this case presentation, symmetric intrauterine growth restriction in high-risk pregnancies should prompt metabolic screening. Despite advances, nonketotic hyperglycinemia remains a devastating condition with high mortality and neurodevelopmental morbidity, emphasizing the importance of further research and early intervention strategies.

This study hypothesises that induced hypothermia (IH) can safely extend aortic cross-clamp (ACC) time, significantly reducing metabolic burden and end-organ injury, thereby enabling more comprehensive aortic arch reconstructions and offering distinct advantages. In this experimental animal research, 62 New Zealand white rabbits were randomized into normothermia (39 °C) and mild hypothermia (35 °C) groups. Animals in each group underwent proximal aortic arch (PAA) clamping for 20, 30, or 40 min. Serial blood samples measured biochemistry, oxidative stress biomarkers, arterial and mixed venous blood gases, and lactate levels. Kidney and liver tissues were harvested for histopathological evaluation of ischaemic changes. Normothermic rabbits experienced significant increases in oxidative stress, metabolic acidosis, and end-organ injury (renal, hepatic, and exclusively, spinal cord injury) with prolonged clamping. Conversely, IH markedly attenuated these adverse effects, preserving acid-base balance and reducing histological injury. Notably, the metabolic burden and end-organ injury observed after 40 min of hypothermic ischaemia were comparable with those after 20 min of normothermic ischaemia, suggesting a substantial extension of safe clamping time. Induced hypothermia during ACC provides significant protection against ischaemia-reperfusion injury by minimising oxidative damage, preserving antioxidant capacity, and maintaining metabolic balance, thereby enhancing haemodynamic function post-surgery. This approach allows for safely extended ACC times, with a safety margin appearing to correspond to 30 min under hypothermia, facilitating complex aortic arch reconstructions and enabling safer surgical training. Clinical trials are warranted to confirm these findings in humans.

ABSTRACTEthylene glycol (EG) is a hazardous alcohol present in various household and industrial products. After being metabolized by ethanol dehydrogenase and aldehyde dehydrogenase, it can produce glycolate, acetaldehyde, and oxalate, leading to acute kidney injury. Renal failure is mainly caused by tubular damage induced by metabolites such as glyoxylate and oxalate, and may also be related to tubular obstruction caused by oxalate crystal precipitation. A 35‐year‐old Chinese man was brought to the emergency department in an unconscious state with a suspected history of EG ingestion. Laboratory examination revealed significant metabolic acidosis with elevated anion gap, acute kidney injury, and hyperkalemia, suggestive of possible EG poisoning. Renal biopsy revealed acute tubular necrosis, with numerous oxalate crystals forming in the tubules of the patient, confirming the diagnosis of EG poisoning with oxalate nephropathy. Treatment included fluid resuscitation, bicarbonate therapy, ethyl alcohol administration, and hemodialysis. After early and active treatment, the patient's consciousness recovered, acidosis improved significantly, and no further dialysis treatment was required.

Patients in the intensive care unit often develop anion gap metabolic acidosis most commonly from lactic acidosis. Clinicians routinely measure serum lactate levels, but it is not clear if one is able to use the measured serum lactate level to determine if there is a second cause for anion gap metabolic acidosis in these critically ill patients. In this report, 503 episodes of lactic acidosis with serum lactate levels greater than 5 mmol/L at a single institution over two years were analyzed. The average serum anion gap minus serum lactate level in these patients was 6.9 ± 0.21 mEq/L, the average corrected anion gap was -1.3 ± 0.23 mEq/L and the average strong ion gap was 5.1 ± 0.3 mEq/L. The majority of the episodes with anion gap-serum lactate concentration >8.0 mEq/L were explained by elevated serum albumin concentration, elevated serum phosphorus concentration, presence of ketones in the urine or high β-hydroxybutyrate concentrations. The above data suggest that one can use the measured serum lactate concentration and subtract from the serum anion gap to determine if there is a second reason for anion gap metabolic acidosis.

Clinically significant fetomaternal hemorrhage (FMH) can have devastating consequences on the newborn infant. Acute FMH close to childbirth can present with hypovolemia, shock, metabolic acidosis, and encephalopathy. Chronic FMH can be associated with congestive heart failure, pulmonary edema, hydrops and hepatomegaly. Early recognition and timely management of FMH are crucial in improving outcomes. This review article summarizes the epidemiology, pathogenesis, diagnosis, management and outcomes of clinically significant FMH. Current knowledge gaps in diagnosis and management of FMH are additionally described.

Dialysis adequacy is an important parameter with regards to morbidity and mortality in chronic haemodialysis (HD) patients. Measuring the adequacy of HD is not an easy task. There is no objective, reliable and universally accepted criteria for measuring the adequacy. Clinically, several parameters must be considered to provide adequate dialysis, such as control of fluid overload and electrolytes disturbance, correction of metabolic acidosis and dialysis dose. This cross-sectional study explores the assessment of the adequacy of haemodialysis by urea kinetic modeling (UKM), a vital method for determining the optimal dialysis dose. This study was conducted at the haemodialysis unit of the National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh between the periods of 1st January 2012 and 30th June 2013. Purposive sampling of 120 end stage renal disease (ESRD) patients on maintenance haemodialysis (MHD) getting dialysis for at least one month through arterio-venous fistula (AVF) and at least 2 dialysis sessions per week. Out of 120 patients, 72 (60%) were male and the ratio was 1.5:1. The mean age of haemodialysis patients in this study was 51 years (range: 18-75 years). Approximately 62 (52%) patients were on an 8-hour per week haemodialysis session. Our study showed mean total clearance of urea normalized or corrected for distribution volume (Kt/V), urea reduction ratio (URR), time average concentration of urea (TACurea) and normalized protein catabolic rate (nPCR) of all study population was 1.21±0.40, 62±12, 83±26, and 1.29±0.46, respectively. In 12 hours per week haemodialysis group achieved target Kt/V &gt;1.2 was only 26 (45%), on the other hand, in 8 hours per week haemodialysis group achieved target Kt/V &gt;2 was only 3 (5%). Among the study population only 52 (43%) patients achieved URR &gt;65%, 13 (11%) patients TACurea was less than 52 mg/dl and 107 (89%) patients achieved nPCR &gt;1g/kg/day. The mean values of the URR was significantly higher for dialysis patients who achieved a Kt/V of &gt;1.2 than for those who did not achieve a Kt/V &gt; 1.2. To achieve haemodialysis adequacy of KDOQI 2006 recommendation needs to increase the frequency of HD that is 3 sessions per week (12 hours/week) and needs to give more attention to other factors that increase urea clearance. To improve patient management with end-stage kidney disease, needs of continuous research to enhance our understanding of haemodialysis adequacy and its dose calculation. Jalalabad Med J 2025; 22 (1): 17-22.

Acid-Base Disturbances After Cardiac Surgery: A Cohort Study Using the Physicochemical Approach.